During transseptal procedures, the clinician typically advances a catheter into the right atrial chamber of the heart and passes a needle intravascularly from the right atrial chamber of the heart, through the atrial septum, and into the left atrial chamber of the heart.
The clinician should ensure that the instruments are desirably situated proximate to the septal wall prior to advancing the needle because of the associated risks in inadvertently puncturing surrounding anatomy. However, because of the inherent properties of the tissue, difficulties with visualization of the septal wall with respect to a position of the instrument is difficult, particularly under fluoroscopic imaging modalities.
Moreover, when passing an instrument such as a needle through the septum, the septal wall may deform and “tent” around the needle and migrate at least partially into the left atrial chamber. This undesirable tenting may be problematic as the preferred path of the needle may be deflected while also bringing the septum closer to other anatomical structures that could be damaged if the needle were to rapidly puncture through the septum.
Thus, methods and apparatus which are able to provide in vivo information with respect to a position of the tissue wall and piercing instrument are desirable. Moreover, methods and apparatus which additionally provide for a counter-traction force with respect to the tissue wall to be pierced are further desirable for inhibiting or preventing tenting of the tissue around the piercing instrument to enhance safety to the patient.